Once an insured's covered out-of-pocket expenses reach the plan's 'stop-loss' (out-of-pocket maximum) for the year, the plan generally:
Explanation
The stop-loss (out-of-pocket maximum) provision caps the insured's annual cost sharing; once the insured has paid that amount in deductibles and coinsurance, the plan pays 100% of additional covered expenses for the remainder of the year, protecting the insured from catastrophic costs. It does not stop the plan's payments, nor shift all remaining costs to the insured, which are the opposite of its purpose. Reaching the stop-loss does not cancel the policy. The provision exists specifically to limit the insured's financial exposure.
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